Lumbar infiltration: 4 types (When to infiltrate, duration, complications?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

You have back pain, and are obviously looking for a way to get rid of your bothersome symptoms! You are therefore looking for the easiest, fastest and most economical solution that currently exists. 

You have already heard of back injections to relieve low back pain, and you are justified in your case. After all, if we infiltrate at the L4-L5 or L5-S1 level (for example, where we have a herniated disc), lower back pain should be gone for good, right? 

In this article, we will discuss 4 different types of back infiltration that exist in medicine, and the best philosophy to adopt when considering their use.

The problem with back infiltration

Let's get started without further ado...

“Is infiltration a therapeutic option when you have back pain? »

Yes.

“Is it sometimes effective? »

Yes.

“Should you consider an infiltration immediately as soon as you have pain? »

Nooooo!

The problem with infiltrations is that they do not necessarily treat the cause of your low back pain. Also, they are not supported by enough scientific evidence. Basically, several studies show that these infiltrations have above all a short term effect, and are no more effective than other more "natural" long-term treatment methods.

It's as if I were telling you that we were going to give you an infiltration at the lumbar level which would probably be unpleasant, and which has risk of not working over time ! On top of all that, you may experience side effects or complications (to be honest, they're rare, but still!).

Side effects and contraindications

As mentioned previously, the side effects and risks of lumbar infiltration are rare. From Side effects the most documented, we have in particular:

• headaches
• bleeding
• the infections
• hematomas
• nausea
• syncope
• numbness caused by nerve irritation
• bone fragility
• elevated blood sugar in diabetics
• allergic reactions to injected drugs

Hard to rejoice, right?! It is for this reason that the list of contraindications to infiltrations is quite long. Situations where it is best to avoid infiltration include:

• Blood clotting disorders (taking anticoagulants)
• Taking aspirin within 3 days prior to any infiltration
• The presence of a local or systemic infection
• An allergy to anesthetic agents
• Extreme fear of needles

It is understood that there are several situations where infiltration is not possible. On the other hand, it sometimes provides benefits that should not be overlooked. Thereby, in which cases should a back infiltration be considered to relieve lower back pain?

The solution: When to infiltrate?

Let's keep the following premise: “Back injections should be considered only in cases of persistent, incapacitating lower back pain that has not responded to conservative treatment for at least 6 weeks. »

This also implies that the patient is not eligible for surgery, or simply does not want to consider this option.

Basically, it should be the last resort before surgery! For those wondering if they should get infiltrated right after a lumbago, a diagnosis of herniated disc or osteoarthritis in the lower back… the answer is no, no, and again no!  

You will therefore understand that infiltration is not something magical (otherwise it would have been prescribed to everyone with back pain or a herniated disc...and the professions of physiotherapists, physiotherapists, and osteos would be obsolete!).

Who can infiltrate you?

Unfortunately, there are many unqualified pseudo-therapists who offer their patients all kinds of infiltration to relieve their back pain, or even cure their herniated disc. Often, these infiltrations use plants or other products derivatives aimed at the relief of symptoms.

The problem is that these products are often poorly studied, which increases the risk of developing side effects, or simply wasting your time and money.

For the record, a 33-year-old man decided to infiltrate itself his own semen thinking it would relieve his symptoms. And this for a year and a half!!! The poor man even developed a large subcutaneous abscess of infectious origin. So if ever the idea of ​​injecting sperm has crossed your mind…we need to talk!

Okay, back to business. At present, lumbar infiltration remains a medical procedure. This means that you have to turn to a qualified doctor to benefit from an infiltration in a scientific, safe and ethical way. Among the doctors who can do infiltrations, we have:

• general practitioners
• orthopedists
• anesthesiologists
• physiatrists (in Quebec)
• radiologists.

The doctor will also ensure that the procedure is as “comfortable” as possible. For example, he may apply anesthetic patches locally to limit pain during the infiltration. He will also tell you when to resume sport, or when to start physiotherapy, physiotherapy or osteopathy sessions.

The different types of infiltration

Well, I dare to hope that you now know a little more about lumbar infiltration. More specifically, you know some advantages and disadvantages related to this practice.

Let's continue the article with the explanation of 4 different types of infiltrations available in medicine today. When the doctor decides that you have to go with the infiltration, he can offer you different types:

Note: Regardless of the type of infiltration, it is always preferable to opt for an infiltration under scanner (or any form of radiological control). This will make it possible to be more precise, and to target the structures most at risk of causing pain (such as nerve roots, intervertebral discs, joint space, etc.)

Epidural

Infiltration epidural is an infiltration aimed at reducing inflammation and pain coming from one or more nerve roots inside the spine. The use of X-rays to confirm the route of the infiltration reduces the risks associated with the procedure.

The best results are observed in people who suffer from radiculopathy due to a herniated disc. Unfortunately, the results are often temporary, and do not last long term.

To know everything about epidural infiltration, see the following article.

facet block

This type of infiltration aims to reduce inflammation and pain coming from the facet joints (for example, if there islumbar arthritis, facet ou zygapophyseal lower back). The doctor will choose to infiltrate this place if he considers that your pain originates from these joints.

If instead he wants to confirm that the facet joints are the source of your pain, he can do this type of infiltration for the purpose of diagnostic. Thus, the results will be satisfactory only if the origin of your pain really came from your facets.

To know everything about the facet block, see the following article.

Trigger point injection

If your doctor feels that one of the trigger points reproduces your pain, he can offer you a cortisone infiltration (or other solution) at this level. They are called trigger point infiltrations (or myofascial infiltration), and they are used when a myofascial syndrome. However, I would say that research shows inconsistent and often temporary results.

To learn more about trigger points, see the following article.

For this reason, I strongly recommend that you consider other treatment options that would be less invasive before opting for this type of infiltration.

For example, dry needles can relax tense muscles, promote local circulation and relieve pain. These types of needles are used by acupuncturists (who use traditional Chinese medicine to guide treatment) or some physiotherapists and physiotherapists (who use a more “medical” and more scientific approach).

Besides, some scientific studies demonstrated that needles under the dermis are as effective as trigger point infiltrations containing a local anesthetic (Novocaine or lidocaine). It should however be mentioned that the pain felt after the needle session under the dermis was more intense and of longer duration in comparison with the patients having benefited from an infiltration.

Sacroiliac infiltration

If your doctor believes that the cause of your pain comes from the sacroiliac, he will first perform some clinical pain provocation tests by stressing that joint in various ways. However, it should be understood that the diagnosis of an attack of this region is controversial, and difficult to prove.

To find out all about sacroiliac pain (including treatment methods), see the following article.

If these tests mimic your usual pain, your doctor may offer you a diagnostic infiltration.

Basically, it involves injecting a local numbing agent (such as lidocaine or bupivicaine) into the sacroiliac joint to determine if you experience (temporary) relief. This infiltration is generally done under fluoroscopy, that is to say guided by a medical imaging.

After the diagnostic infiltration, the doctor might re-test movements that were previously painful. If you feel less pain in general, we can conclude that the sacroiliac joint was inflamed.

We will then concentrate the treatment around the sacroiliac, for example with subsequent infiltrations. If, on the contrary, there is no therapeutic effect, this would mean that your symptoms come from another structure, or from another cause.

If you ever have to resort to the needle (as a last resort before the surgery, remember!), one infiltration may not be enough. Although the precise number or recommended interval between each infiltration is controversial, experts recommend a series of 1 to 3 infiltrations at intervals of at least 1 month.

Above all, do NOT perform subsequent infiltrations if the previous one did not bring positive results!

After how long does a lumbar infiltration take effect? 

What happens immediately after the infiltration (lumbar or other)? Some think that their pain will go away as soon as the doctor finishes his procedure. Or that their herniated disc will resolve immediately.

Unfortunately, this is almost never the case.

Without wanting to frighten you, some patients claim to have more pain lumbar immediately after infiltration. Because yes, a lumbar infiltration hurts in the majority of cases. But it's complitly normal. After all, an infiltration is an invasive procedure, and the tissues are irritated because of the needle used.

This is the reason why many doctors will recommend to their patients not to drive after the intervention. If we add the potential post-infiltration side effects, it is indeed better to take a taxi or ask for help. 

Today, how long after the infiltration can we expect a decrease in pain?

The answer varies depending on the type of infiltration and the patient, but doctors usually mention 3 to 7 days before seeing an effect. It is not uncommon to see an improvement after 2 weeks post-infiltration. In short, be patient, and trust the doctors.

The doctor will probably give you a work stopping after back infiltration. This stop will depend on the physical demands of your job. He will also ask you to maintain your spine in a neutral position, that is to say to avoid extreme positions of flexion, extension or twist in the first times.

Un application of ice to the lower back will reduce pain and local inflammation (caused by the needle). Some patients will prefer to opt for heat packs aimed at reducing muscle spasms and tension, and inducing a relaxed environment. This will relieve pain after an infiltration.

Ideally, the doctor will also prescribe physiotherapy (physiotherapy) sessions to optimize your rehabilitation. Indeed, since the inflammation is under control (thanks to cortisone), the body is in an optimal environment conducive to healing.

Resuming sport after infiltration

Another question that torments the minds of patients is the resumption of physical activities after an infiltration (lumbar or other).

Again, your doctor is best able to answer you depending on the type of infiltration, and your personal condition. Generally, a rest of about 24-48 hours post-infiltration is recommended. But some doctors advise their patients to wait at least a week before resuming sport.

Here's the most important thing to keep in mind: Whatever your hobby, resume gradually after infiltration. This implies that you have to adapt your physical activity, take more breaks, etc.

Obviously, some physical activities will require a longer transition period (such as contact sports). A physiotherapist is the most qualified to allow you to resume your leisure activities in an optimal way.

alternatives

As mentioned previously, lumbar infiltration should be used as a last resort before surgery.

Thus, it is essential to try various approaches before resorting to infiltration. Time and medication are generally not enough to treat back pain, especially if you want to correct the cause and prevent recurrences.

The ideal would be to consult a professional such as a physiotherapist (physiotherapist) or osteopath to set up a treatment based on manual therapy and therapeutic exercises.

Apart from infiltration and physical therapies, there are several products and accessories available on the market to relieve lower back pain. It should be remembered that these tools generally provide temporary relief, and should be used sparingly.

Among the products recommended by our professionals, we have:

• acupressure mat

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• Heated lumbar belt

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• Postural T-Shirts

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• Ergonomic back cushion

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• massage gun

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• Spinal decompression table

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• Foam roller (sport massage roller)

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In sum, there are many natural solutions aimed at relieving back pain without resorting to medication, infiltration or surgery.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

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• Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

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• Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 

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• Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

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• wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

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Conclusion

To sum up, I don't advise you to have an infiltration if you see progress in your condition with conservative treatment, however minimal it may be.

So, instead of opting for an infiltration that can potentially bring no benefit, it is better to focus on more “natural” methods aimed at relieving your symptoms.

For example, have you tried the McKenzie method? Or, techniques of breathing or meditation? Obviously, do not underestimate the importance of thephysical exercise (adapted to your condition, of course!).

In short, there is always something to do to help you get better!

If you see a therapeutic plateau (a halt in the progress of your condition), associated with persistent pain preventing you from going about your business, you can think at this time of a more invasive intervention such as an infiltration.

Obviously, I strongly recommend that you speak with a health professional so that he can guide you on the various possible options. 

References

https://www.aafp.org/afp/2002/0215/p653.html